Anesthesia Coding Alert

Question: We keep getting an edit stating that the "33" and "PT" modifiers are not correct anesthesia modifiers for colonoscopies billed to Medicare. The question that I'm trying to get an answer for is what the correct sequence is when coding the anesthesia. Would the 33/PT be placed before the AA, QK, QX or after?

Alabama Subscriber

Answer: Medical direction modifiers such as AA (Anesthesia services performed personally by anesthesiologist), QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals), or QX (CRNA service: with medical direction by a physician) typically comes first on a claim because they have a greater effect on your reimbursement. Modifiers PT (Colorectal cancer screening test; converted to diagnostic test or other procedure) and 33 (Preventive services) are payment/informational modifiers that will affect payment by waiving a portion of the patient's out of pocket expenses.

Extra info: You'll use modifier 33 in the second position to communicate to your payer that your physician performed a preventive service, such as a screening for colonoscopy so make certain the surgeon's office is providing an appropriate screening diagnosis.

Based on the 33 modifier, the payer may waive the patient's co-insurance, co-payment, and deductible for the applicable services. However, if a polyp is removed, you'll use modifier PT in the second position to communicate to your payer that the screening test converted to a procedure. Based on the PT modifier, the payer may waive the patient's deductible and the patient will still be responsible for the co-payment. Make sure you are getting these modifiers reported correctly, as it affects how much out-of-pocket your patient pays.

Remember: Modifiers are reported in a certain pecking order:

1. Payment
2. Payment/statistical or payment/informational (which mean the same thing)
3. Statistical